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ICD-10 Guide
ICD-10 CodesK31.6

K31.6

Billable

Fistula of stomach and duodenum

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 K31.6 is a billable code used to indicate a diagnosis of fistula of stomach and duodenum.

Key Diagnostic Point:

Fistula of the stomach and duodenum refers to an abnormal connection between the stomach or duodenum and another organ or structure, which can arise due to various underlying conditions such as peptic ulcers, malignancies, or post-surgical complications. Clinically, patients may present with symptoms such as abdominal pain, nausea, vomiting, and signs of malnutrition or dehydration due to impaired digestion and nutrient absorption. The anatomy involved includes the stomach, duodenum, and potentially adjacent organs like the pancreas or intestines. Disease progression can lead to serious complications, including infection, sepsis, and significant fluid and electrolyte imbalances. Diagnostic considerations include imaging studies such as CT scans or endoscopy to visualize the fistula and assess its extent. Laboratory tests may also be performed to evaluate nutritional status and electrolyte levels. Early diagnosis and intervention are crucial to prevent further complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly endoscopic evaluation.
  • Treatment complexity: May involve surgical intervention or management of underlying conditions.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis.
  • Coding specificity: Requires accurate coding to differentiate from other gastrointestinal conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of fistula or related conditions.
  • Documentation gaps: Incomplete clinical notes regarding the patient's history and treatment.
  • Billing challenges: Difficulty in justifying the medical necessity of procedures related to fistula management.

Specialty Focus

Medical Specialties

Gastroenterology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

General Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Fistulas of the stomach and duodenum can significantly impact patient quality of life and healthcare utilization. They often require complex management, leading to increased hospital admissions and prolonged recovery times. Understanding the epidemiology of these conditions can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may focus on timely diagnosis and effective management strategies to reduce complications and improve patient outcomes.

ICD-9 vs ICD-10

Fistulas of the stomach and duodenum can significantly impact patient quality of life and healthcare utilization. They often require complex management, leading to increased hospital admissions and prolonged recovery times. Understanding the epidemiology of these conditions can help healthcare providers identify at-risk populations and implement preventive measures. Quality measures may focus on timely diagnosis and effective management strategies to reduce complications and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity of surgical interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to fistula management. Best practices include thorough documentation of the patient's clinical status, treatment rationale, and outcomes to minimize audit risks and ensure appropriate reimbursement.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for K00-K99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by K31.6?

K31.6 covers fistulas that develop between the stomach or duodenum and other structures, often resulting from conditions like peptic ulcers, malignancies, or surgical complications. It is essential to document the underlying cause to support the diagnosis.

When should K31.6 be used instead of related codes?

K31.6 should be used when there is a confirmed diagnosis of a fistula specifically involving the stomach or duodenum, distinguishing it from other gastrointestinal fistulas or conditions that may not involve these specific organs.

What documentation supports K31.6?

Documentation should include clinical findings, imaging results, and any surgical reports that confirm the presence of a fistula. Detailed notes on the patient's symptoms, treatment plan, and response to therapy are also critical.